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Neurological Surgery No Shinkei Geka Volume 44, Issue 6 （June 2016）

Neurological Surgery 脳神経外科 44巻6号（2016年6月発行）

Japanese English

症例

著明な多形性を伴った松果体実質性腫瘍—悪性度との相関はいかに Pineal Parenchymal Tumor with Marked Cytologic Pleomorphism:Is there a Correlation with the Malignancy Grade? 伊東民雄 ¹ , 佐藤憲市 ¹ , 尾崎義丸 ¹ , 浅野目卓 ¹ , 中村博彦 ¹ , 田中伸哉 ² , 木村太一 ³ , 菅野宏美 ⁴ Tamio ITO ¹ , Kenichi SATO ¹ , Yoshimaru OZAKI ¹ , Taku ASANOME ¹ , Hirohiko NAKAMURA ¹ , Shinya TANAKA ² , Taichi KIMURA ³ , Hiromi KANNO ⁴ ¹中村記念病院脳神経外科脳腫瘍センター ²北海道大学大学院医学研究科病理学講座腫瘍病理学分野 ³北海道大学大学院医学研究科探索病理学講座（寄附講座） ⁴北海道大学病院病理部 ¹Department of Neurosurgery, Brain Tumor Center, Nakamura Memorial Hospital ²Department of Cancer Pathology, Hokkaido University Graduate School of Medicine ³Department of Translational Pathology, Hokkaido University Graduate School of Medicine ⁴Department of Surgical Pathology, Hokkaido University Hospital キーワード： pineal parenchymal tumor , pleomorphism , proliferative potential , malignancy Keyword: pineal parenchymal tumor , pleomorphism , proliferative potential , malignancy pp.481-487

発行日 2016年6月10日 Published Date 2016/6/10

DOI https://doi.org/10.11477/mf.1436203314

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Ⅰ．はじめに

　松果体実質性腫瘍（pineal parenchymal tumors：PPTs）のうち，pineocytoma（PC）やpineal parenchymal tumor of intermediate differentiation（PPTID）では，ときに多形性を伴うことがあるが，本所見と悪性度との相関については議論のあるところである^2,8,10)．

　今回われわれは著明な多形性を伴ったPPTの1例を経験したので，自験PPTs 12例（PC：3，PPTID：6，pineoblastoma（PB）：3）の病理所見との比較より^4,7)，本症例の病理診断および多形性と悪性度との相関について文献的考察を行ったので報告する．

　Introduction:In benign pineal parenchymal tumors（PPTs), namely, pineocytoma（PC）and PPT of intermediate differentiation（PPTID), cytologic pleomorphism has occasionally been found;however, it is controversial as to whether the presence of pleomorphic cells leads to upgrading of tumors. We experienced a rare case of pleomorphic PPT in an elderly woman and compared it with a retrospective series of 12 PPTs（PC:3, PPTID:6, pineoblastoma［PB］:3）to evaluate the correlation between pleomorphism and the malignancy grade.

　Case and materials:A 76-year-old woman presented with gradual cognitive deterioration and gait disturbance. Gadolinium-enhanced magnetic resonance imaging（Gd-MRI）revealed a small, enhanced tumor in the pineal gland with marked hydrocephalus. Endoscopic tumor biopsy and third ventriculostomy were performed simultaneously. The tumor was soft, pinkish, and slightly hemorrhagic. After the biopsy, the patient underwent gamma knife radiosurgery.

　Pathological findings:The PPT presented with areas of tumor cells forming pineocytomatous rosettes and areas of giant and multinucleated cells with hyperchromatic nuclei. Neither mitosis nor necrosis was observed. The tumor cells were positive for synaptophysin（SYN）and neurofilament（NF), but negative for glial fibrillary acidic protein（GFAP）and oligodendrocyte lineage transcription factor 2（Olig2). The MIB-1 labeling index（LI）was 8.1%. There was no difference in the MIB-1 LI between pleomorphic and non-pleomorphic areas. All the 12 PPTs were immunopositive for the neuronal markers SYN and NF. The MIB-1 LI was 0% in PC, 3.5% in PPTID, and 10.5% in PB. The proliferative potential was correlated with the WHO grade. From these findings, the final diagnosis of this pleomorphic case was PPTID grade II, not PC, because the MIB-1 LI was relatively high, even though some tumor cells were forming pineocytomatous rosettes.

　Conclusion:Although cytologic pleomorphism in PPTs is generally considered not to be correlated with the malignancy grade, the final pathological diagnosis should be determined while considering the proliferative potential.